Tom Wright - Changing practice for later life


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Tom Wright, Group Chief Executive, Age UK presentation from the For Later Life conference on 25th April.
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  • Age UK has a vision of a world where older people flourish. We are here to stand up for the 14 million people in the UK and 846 million internationally who have now reached later life, but also to speak for the long-term interests of every one us. So, how are we doing? Each year, Age UK stands back and takes an overview of how society is meeting the needs of people in later life. The results, together with our priorities for the year ahead, are published in Agenda for Later Life, the report published today that you will find on your seats. This year, we’ve sub-titled our report ‘Improving quality in tough times’ and there is no denying the economic and financial challenges we face. But these tough times are also stimulating new ways of doing things, changing practice and culture, and that’s what we want to focus on in our conference today.
  • Each year, we track a number of indicators to help us evaluate progress. And there is much to celebrate The numbers of people aged 60-plus continues to increase, and there are now over 14 million people aged 60+ in the UK. And this pattern is global. By 2050 there will be 2 billion people aged 60+, of whom 80 per cent will live in lower and middle income countries. What is more remarkable, in the UK we stand on the verge of an explosion in the numbers of people aged 85+, which have edged up to 1.38 million this year, but is forecast to double in the next 20 years.
  • As you can see from this chart, this change will be particularly pronounced in some parts of the country – those with darkest shade of green. What was formerly a small group of exceptional individuals is rapidly becoming a whole new generation, and the fastest growing one at that. People who make the key decisions concerning their welfare need help to get up to date with their nature and needs. That’s why, this year we asked experts to write summaries of what is known in their area of research about this age group. We’ve collected these lay-person summaries into a short book, ‘Improving later life 2’ which is available on the publication stand in the display area.
  • Increasing longevity is to be welcomed but a fulfilling, dignified life, is equally important. This year, for the first time, we asked the general public how confident they are that older people are treated with dignity in hospital and when receiving social care. The results were alarming. Only 31% are confident that older people are treated with dignity in hospital. Only 26% are confident that older people are treated with dignity when receiving social care. A quarter of older households live in properties that fail the decent homes test, often because they are cold – which in itself increases the risk of illness. That is why we have a particular focus on health and social support in our conference today. Our research was carried out before the publication of the Francis Report into failings at Mid-Staffs NHS Trust, but as you will see from this quotation, the Francis Inquiry underlined yet again the need for change. Last year Age UK came together with the Local Government Association and the NHS Confederation to establish the Commission on Dignity in Care which published its recommendations in a report, ‘Delivering Dignity’, last summer. This work has been extremely influential in getting ‘dignity’ on the map and has helped to shape the emerging agenda. You’ll hear more about that from Dianne Jeffrey in our plenary session this afternoon, and we are delighted that we will be joined by the Secretary of State, Jeremy Hunt.
  • I want to turn now to what Age UK’s annual indicators tell us about the overall position of older people. The good news is that relative poverty continues to fall, the employment rate for people coming up to retirement has edged upwards and nearly a million people over 65 are in work. Those not in work of course are often still contributing, too, with 28% of people aged 65 to 74 volunteering regularly, and just under 20% of those aged 75+. But poverty remains shockingly high, affecting nearly one in six pensioners. Around a third of pensioners are still not receiving the means-tested benefits to which they are entiltled, and an estimated 3.5 million older households are in fuel poverty in the UK, which has serious implications for the health of our older population. These indicators are not improving. The picture for tomorrow’s pensioners is worrying too. People over 50 who are out of work are more likely than any other group to be long-term unemployed. And the percentage contributing to a private pension continues to fall. We hope that this is the low point, as the system of automatic enrolment into a private pension, with a contribution from your employer, started to be rolled out from last October.
  • Health shows the same pattern of inequality. Although healthy life expectancy from age 65 is rising, it is increasing at a slower rate than life expectancy. And the length of time someone of 65 can expect to live on average without a disability varies hugely between local authorities. People in the local authority with the worst experience acquire disabilities around 12 years earlier, on average, than people in the authority with the best figures. We call this the ‘disability gap’ and worryingly it has widened substantially since 2006. The lesson we draw from this is that while we have made huge strides, over the last century, in tackling disease and injury, we have been less good at preventing, delaying and managing long-term illness. Our model of health care is centred round curing, rather than preventing. Perhaps the most graphic example of this is number of older people who continue to be sent home from hospital either too early or without adequate support, only to be readmitted as an emergency. The number of emergency hospital readmissions for people aged 75+ has risen to over 200 thousand a year. The financial cost is an estimated £1.8 billion, but the human cost is far higher. Is this really a sustainable way of using public funds that delivers good outcomes for people? We would argue that it is not, and the system need to transform to offer coordinated care that is organised round people’s needs.
  • The same applies with care. The numbers of people receiving state-funded care or support at home is also shrinking, dropping from 437 thousand to under 415 thousand, however at the same time we know that need is growing due to demographic changes. We estimate that around 800,000 people are not receiving the care they need, and are forced to struggle on alone, or depend on family and friends. This in turn has a knock-on effect, with 300,000 people forced to leave the workforce last year to provide care at a cost to the economy of over £5 billion. Yet the numbers of carers receiving carer-specific support is also dropping. This simply doesn’t make sense.
  • We all, of course, aspire to do more than simply exist so we also track a number of lifestyle indicators. Many older people remain isolated and a shocking 770,000 older people say they are often or always lonely. 13% of people find it difficult to reach their corner shop – a figure which shows no change from last year. Being able to participate through the internet should be a real help to people in this position but although digital exclusion is falling, it’s not dropping fast enough. The numbers of people aged 75+ who have never used the internet has fallen, but only by 1 percentage point. This is likely to be an increasing problem for older people as key services move online. We need to improve access to key services and consumer markets, if we are to unlock older people’s spending power. Older households’ importance to the economy is highlighted by the large increase in their annual spending, as shown in this chart – up from £109 billion to £121 billion. But it could be more - with some honourable exceptions, the private sector has yet to wake up to the opportunities before them.
  • So overall, as this table shows, our indicators tell us that we are living longer, in better financial health, but that financial and health inequalities persist and in some cases are widening. Our indicators round health and social care are particularly worrying, with serious implications for the quality of life of older people.
  • Faced with this uneven picture, how do we begin to change things round? First of all, some developments over the past year have given us real heart. Since Christmas we have seen major announcements on care funding and reform of state pensions. Neither goes as far as Age UK would like, but we support the principles behind them. Following the publication of the Francis Inquiry, the Government has recognised the need for culture change in health and care. We’ll hear about that in our plenary session this morning and when we are joined by the Secretary of State, Jeremy Hunt. Another encouraging step is political recognition of the need to get ‘ready for ageing’. Rcently an influential Committee of the House of Lords has warned that as a society we are woefully unprepared for ageing and called on the Government to publish a white paper setting out how we need to change. But what about Age UK and our top priorities as a charity for the year ahead?
  • In our Agenda for Later Life report you will see details of our policy priorities. But fundamental to this is a culture change across the public and private sectors, valuing the contributions and recognising that older people want to live ‘later life with attitude’. Underpinned by sufficient income to live comfortably and participate fully. With a much greater emphasis on preventative healthcare. With care and support that adapts to fit the individual rather than expecting the individual to adapt to the system. With adequate funding for social care so that the most vulnerable are not left to fend for themselves. Supporting and valuing local networks that can deliver those joined-up services And with a recognition that we are part of an global movement, through our work with our subsidiary charity Age International Pulled together by a cross-governmental action plan. And finally, what of Age UK?
  • Our role, and the focus of the rest of our conference, is working in partnership to change policy and practice for a better later life. And as just one example, we are looking at how we can improve the health and wellbeing of people living with multiple health conditions by bridging the gap between local health and care services. Age UK Cornwall and the Isles of Scilly is working collaboratively with local health bodies to help older people at risk of unplanned hospital admissions to manage their health. I’d like to show you now a short film about the project to set the scene for our next session.
  • Tom Wright - Changing practice for later life

    1. 1. Changing practice for later lifeTom Wright CBEGroup Chief Executive, Age UK
    2. 2. Age UK has a vision of aworld where older people flourish• How are we doing?• What are our top policypriorities for the year ahead?• How can we change culturesand practice?
    3. 3. Increasing longevity- cause for celebrationUK 60+ population UP from 13.8m to 14.1mUK life expectancy at 75: UP for men from 11.6 to 11.8 years UP for women from 13.1 to 13.3 yearsWorld population UP for 60+ from 820m to 846m UP for 85+ from 46.9m to 49.4m
    4. 4. Increase in 85+ population by 2030
    5. 5. Living with dignity?×Only 31% of the public are confident that older people aretreated with dignity in hospital×Only 26% are confident that older people receiving socialcare are treated with dignity×26% of households aged 60+ live in non-decent housing‘We need a patient centred culture, no tolerance of noncompliance with fundamental standards, openness andtransparency, candour to patients, strong cultural leadershipand caring, compassionate nursing, and useful andaccurate information about services.’Robert Francis QC
    6. 6. Wealth and income are unevenly spreadPoverty falling from 15% to 14%50-64 employment up from 65.2% to 66.6%65+ employment up from 885,000 to 967,000Volunteering among those 65-74 steady at around 28%BUT×Benefit take-up stationary - around 1/3 not claiming×Fuel poverty rising from 2.75m to 3.5m×Private pension saving falling from 38% to 37%
    7. 7. Health gaps are wideningHealthy life expectancy at 65:UP for men for 9.9 to 10.1 yearsUP for women from 11.5 to 11.6 yearsBUTDisability gap:×UP for men from 10.2 to 12.1 years×UP for women from 11.5 to 12.3 years×Hospital readmissions UP from 187,891 to 201,571
    8. 8. State-funded support is shrinking×Numbers 65+ receiving care or support at home DOWNfrom 437,150 to 414,780×800,000 people with unmet care needs×Carers receiving carer-specificsupport DOWN from87,105 to 79,830
    9. 9. A more fulfilling later life?×Often or always lonely: 770,000• Physical access – 13% find it difficult to reach their corner shopHave never used the internet:65-74 down from 40.1% to 34.5%75+ down from 70.8% to 69.1%Annual spending upfrom £109bn to £121bnAnnual spending
    10. 10. How are we doing?
    11. 11. Ready for Ageing?‘The UK population is ageing rapidly, but we have concludedthat the Government and our society are woefullyunderprepared. Longer lives can be a great benefit, but therehas been a collective failure to address the implications andwithout urgent action this great boon could turn into a series ofmiserable crises.’Lords Select Committee on Public Service andDemographic Change, March 2013
    12. 12. Age UK’s priorities for 2013-14• ‘Later life with attitude’ - valuing the contribution andrecognising the needs of older people• Sufficient income to live comfortably and participate fully• Healthcare focused on preventing poor health andmanaging long-term conditions• Joined-up care and support• Address unmet need in social care• Supporting and valuing local networks such as Age UK• Active promotion of the rights of older people globally• A cross-governmental action plan showing how publicservices will be re-designed for our ageing society
    13. 13. Age UK’s roleChanging policy and practice for later life